Chapter 31: Geriatric Emergencies Thacher Wastrom Old Shredder

Physiological Changes 1.Neurological changes Slower data processing Cerebral blood flow reduced Nerve impulses slowed Inner ear – balance 2.Cardiovascular changes Walls of ventricles stiffer Blood vessels stiffer – increased resistance 3.Respiratory Changes Decreased elasticity of lungs Decreased vital capacity

Physiological Changes 4.Gastrointestinal Changes Activity levels in pancreas and liver Higher risk for GI disorders (obstructions, ulcers) 5.Changes in Renal Function and Electrolyte Balance Kidneys become less effective at filtering toxins, waste, drugs Decrease in total body water (30%) 6.Musculoskeletal Changes Lower bone density and muscle mass Osteoporosis, Scoliosis, Kyphosis, Lordosis 7.Integumentary Changes Skin thins by 20%, less elastic Predisposed to bruising, tearing, heat loss

Common Geriatric Illnesses and Conditions 1.Altered Mental Status Alzheimer's, Dementia Also caused by hypoxia, hypoglycemia, etc. 2.Hypertension Affects 2/3 of all seniors 3.Myocardial Infarction Increased risk w/ hypertension, high cholesterol, diabetes, family history, smoking S/S: chest pain, numbness, shortness of breath, feelings of unease

Common Geriatric Illnesses and Conditions 4.Congestive Heart Failure Ineffective pumping 5.Syncope More serious w/ elders  underlying issue 6.Stroke Elderly have highest risk of stroke 7.COPD Elderly at greatest risk; from smoking / occupational exposure Made worse by poorer gas exchange 8.Abdominal Emergencies Ex: bowel obstruction or rupture, GI bleeding Rapid transport

Medication Use in Elderly Polypharmacy: simultaneous use of several medications in combination Beta-Blockers: make heart contract more efficiently; used to lower blood pressure Calcium-Channel Blockers: reduce heart rate and blood pressure Blood Thinners: reduce risk of heart attack and stroke by reducing formation of blood clots

Trauma Considerations Falls 12% of deaths in geriatric population Underlying medical problems Hip and Pelvic Fractures Falls, crashes Bleeding complications Traumatic Brain Injury Brain shrinks Minor trauma  serious Blood thinners Cervical Spine Injury Weakened neck muscles + osteoporosis

Additional Considerations Artificial joints Ex: shoulder, hip, knee Dislocate easily Implantable devices Ex: pacemakers, cochlear devices External openings, ports, apparatus Ex: urinary catheter Communicating with elderly patients Eye contact, normal speaking voice Address as Mr. / Mrs. / Ms. (not demeaning nicknames) Medications SAMPLE High index of suspicion